摘要：Objectives. We analyzed correlates of older Americans’ continuous and transitional health care utilization over 4 years. Methods. We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004–2008 survey periods. Results. Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction. Conclusions. Older individuals’ health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms. In choosing to seek medical care, individuals weigh the financial cost of treatment against its perceived benefit to their health. Clearly physician input, in combination with the presence and generosity of health insurance coverage, weighs heavily in this decision. As individuals age they begin to experience the onset of new health conditions at the same time that their households often begin to deplete their savings to finance retirement. 1–4 Because of these new experiences and potentially limited financial resources, older individuals may become more selective in which types of care they receive, perhaps focusing first on their most pressing medical needs or delaying or skipping procedures prescribed by their physician that they deem relatively costly or not immediately necessary. Studies have investigated the differences in health care expenses for the elderly by health status and changes in health status, 5 the changes in health related to persistence or changes in health insurance coverage for the near elderly, 6 correlation between health and health insurance coverage, 7,8 and the relationship between functional change and hospital use and cost. 9 None of these studies, however, has focused on the relative importance of financial versus health factors in determining an elderly population’s persistent or intermittent health care use over time. The motivation for our study comes from a related recent analysis we conducted showing that dental use was surprisingly resistant to changes in household net wealth and household income. 1 We found that only when household net wealth falls by 50% or more were older adults less likely to seek dental care. 1 This finding inspired our interest in pursuing related findings for medical care. In this study, we determined correlates of continuous and intermittent health care use for a population of civilian, noninstitutionalized Americans older than 50 years. This population is of particular concern because they consume an increasingly disproportionate share of health care as the baby boomer generation advances to the top of the national age distribution. We investigated the relative strengths of financial factors and health factors at 1 point in time and over time as correlates of this older population’s altering or continuing medical care use. Our analysis is particularly relevant at a time when the financial status of many US households has been affected adversely by economic conditions. 10 We used longitudinal data from the 2006 and 2008 waves of the Health and Retirement Study (HRS) to explore health and financial factors associated with older adults’ changes in and persistence of health care use between these periods, including (1) physician visits, (2) overnight hospital stays, (3) outpatient surgery, and (4) home health care. We hypothesized for this population that health factors would outweigh financial factors in explaining continuous and intermittent health care use over this period.
